Provider Demographics
NPI:1811249667
Name:CHIROPRACTIC OF THE SOUTH, PLLC
Entity type:Organization
Organization Name:CHIROPRACTIC OF THE SOUTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR./OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:SLOANE
Authorized Official - Last Name:FORTINBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:601-605-0903
Mailing Address - Street 1:1029 HIGHWAY 51
Mailing Address - Street 2:STE. F2
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-6603
Mailing Address - Country:US
Mailing Address - Phone:601-605-0903
Mailing Address - Fax:601-510-9415
Practice Address - Street 1:1029 HIGHWAY 51
Practice Address - Street 2:STE. F2
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-6603
Practice Address - Country:US
Practice Address - Phone:601-605-0903
Practice Address - Fax:601-510-9415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-03
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1189111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty